Provider Demographics
NPI:1215029657
Name:LIEB, HELENE A (EDD)
Entity Type:Individual
Prefix:MS
First Name:HELENE
Middle Name:A
Last Name:LIEB
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DERBY ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-1546
Mailing Address - Fax:781-740-0212
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 16
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-1546
Practice Address - Fax:781-740-0212
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4459103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
W04363Medicare ID - Type Unspecified